Factors associated with Healthcare Effectiveness Data and Information Set (HEDIS) alcohol and other drug measure performance in 2014–2015

Figures & data

Table 1. Characteristics of patients with an index alcohol or drug abuse/dependence encounter in 7 health systems by site, October 1, 2014, to August 15, 2015 (N = 86,565).

	Health system
Characteristic	A	B	C	D	E	F	G	P value
Sex, %
Female	40.8	37.6	40.8	36.5	44.6	41.5	44.2
Male	59.2	62.4	59.2	63.5	55.4	58.4	55.8	<.001
Age, %
18–29	22.2	16.9	24.3	21.6	19.8	22.1	17.1
30–49	31.3	17.9	29.0	28.1	27.6	30.8	37.8
50–64	29.0	37.9	28.1	29.2	33.2	29.4	30.2
65+	17.5	27.3	18.6	21.2	19.5	17.8	14.9	<.001
Race/ethnicity, %
American Indian/Alaska Native	1.3	0.7	1.2	0.7	2.2	1.5	8.1
Asian	0.9	0.6	5.6	3.3	2.4	1.5	0.1
Native Hawaiian/other Pacific Islander	0.3	0.0	0.8	0.5	0.8	0.7	0.1
Black/African American	4.7	39.3	12.4	11.1	4.1	4.5	2.3
Hispanic	14.2	1.7	17.3	30.4	3.4	4.4	0.7
White	64.4	50.7	60.5	50.9	66.9	83.7	88.3
Other/unknown	14.2	7.0	2.2	3.0	20.2	3.6	0.4	<.001
Substance abuse–related psychiatric conditions in the year prior, %	42.9	45.1	43.2	43.7	45.6	47.0	56.0	<.001
Substance abuse–related medical conditions in the year prior, %	58.4	74.4	66.0	60.6	61.4	63.7	66.7	<.001
Charlson comorbidity Index, mean (SD)	0.90 (1.72)	1.34 (1.96)	1.12 (1.93)	0.91 (1.68)	0.97 (1.77)	1.06 (1.86)	0.77 (1.36)	<.001
Insurance type, %
Commercial/private pay	65.0	67.5	61.4	67.0	64.8	57.7	0.0
Medicare	22.7	32.5	26.8	23.9	26.9	15.3	0.0
State subsidized	12.3	0.0	11.9	9.1	2.7	27.0	0.0
Unknown	0.0	0.0	0.0	0.0	5.6	0.0	100.0	<.001
Type of index diagnosis, %
Alcohol	59.8	53.4	50.8	51.9	51.5	52.7	50.5
Cannabis	14.5	12.9	15.8	14.9	16.6	16.0	9.0
Opioids	9.0	13.3	9.9	16.3	15.8	13.7	11.8
Other drug	16.8	2.0	23.5	16.9	16.1	17.6	28.8	<.001
Index encounter type, %
Primary care	20.3	48.1	21.8	16.5	14.5	21.6	19.8
Emergency department	29.3	16.8	14.9	50.7	53.9	31.2	57.2
Inpatient	29.6	15.0	47.6	13.1	16.1	24.9	3.6
Psychiatry/AOD treatment	9.5	6.6	9.9	14.2	7.8	14.3	9.9
Other outpatient	11.4	13.5	5.8	5.5	7.7	8.0	9.4	<.001
Treatment utilization 45 days post index encounter, mean(SD)
Primary care	0.58 (0.99)	0.61 (0.98)	1.08 (1.82)	0.71 (1.16)	1.29 (2.96)	0.76 (1.12)	3.20 (3.62)	<.001
Emergency department	0.03 (0.27)	0.14 (0.45)	0.31 (0.83)	0.12 (0.47)	0.23 (0.80)	0.28 (0.77)	0.07 (0.34)	<.001
Psychiatry/AOD treatment	0.65 (1.98)	0.98 (3.35)	3.45 (14.90)	1.70 (7.91)	0.70 (2.74)	0.51 (2.68)	0.25 (1.16)	<.001

Table 2. Characteristics of patients with an index alcohol or drug abuse/dependence encounter by treatment initiation* and engagement**.

	Initiated treatment		Did not initiate treatment			Engaged in treatment		Did not engage in treatment
	(n = 7,995)		(n = 62,084)			(n = 2,782)		(n = 21,406)
Characteristic	n	%	n	%	P value	n	%	n	%	P value
Sex
Female	3,000	37.5	24,439	39.4		1,063	38.2	8,659	40.5
Male	4,995	62.5	37,645	60.6	.002	1,719	61.8	12,747	59.6	.023
Age
18–29	1,902	23.8	14,466	23.3		645	23.2	3,988	18.6
30–49	2,744	34.3	18,885	30.4		1,086	39.0	5,084	23.8
50–64	2,351	29.4	17,802	28.7		814	29.3	6,690	31.3
65+	998	12.5	10,931	17.6	<.001	237	8.5	5,644	26.4	<.001
Race/ethnicity
American Indian/Alaska Native	98	1.2	861	1.4		35	1.3	317	1.5
Asian	257	3.2	2,246	3.6		87	3.1	719	3.4
Native Hawaiian/other Pacific Islander	45	0.6	384	0.6		16	0.6	127	0.6
Black/African American	669	8.4	5,988	9.6		181	6.5	2,429	11.4
Hispanic	1,397	17.5	12,656	20.4		494	17.8	3,635	17.0
White	5,074	63.5	36,589	58.9		1,785	64.2	13,301	62.1
Other/unknown	455	5.7	3,360	5.4	<.001	184	6.6	878	4.1	<.001
Substance abuse–related psychiatric conditions in the year prior	4,138	51.8	25,484	41.1	<.001	1,504	54.1	11,240	52.5	.123
Substance abuse–related medical conditions in the year prior	4,858	60.8	35,728	57.6	<.001	1,697	61.0	16,766	78.3	<.001
Type of index diagnosis
Alcohol	4,318	54.0	32,574	52.5		1,511	54.3	10,741	50.2
Cannabis	673	8.4	9,480	15.3		197	7.1	3,404	15.9
Opioid	1,331	16.7	8,510	13.7		561	20.2	2,402	11.2
Other drug	1,673	20.9	11,520	18.6	<.001	513	18.4	4,859	22.7	<.001
Index encounter type
Inpatient	n/a	n/a	n/a	n/a		—	—	—	—
Primary care	2,312	28.9	29,456	47.5		—	—	—	—
Emergency department	2,749	34.4	19,804	31.9		—	—	—	—
Psychiatry/addiction treatment	2,400	30.0	7,644	12.3		—	—	—	—
Other outpatient	534	6.7	5,180	8.3	<.001	—	—	—	—
Initiation encounter type
Inpatient	—	—	—	—		246	8.8	7,357	34.4
Primary care	—	—	—	—		280	10.1	2,302	10.8
Psychiatry/AOD treatment	—	—	—	—		1,584	56.9	1,956	9.1
Other outpatient	—	—	—	—		218	7.8	3,164	14.8
Unknown	—	—	—	—		454	16.3	6,627	31.0	<.001
	Mean	SD	Mean	SD	P value	Mean	SD	Mean	SD	P value
Charlson comorbidity Index in year prior	0.72	1.43	0.76	1.51	.012	0.77	1.56	1.67	2.28	<.001
Treatment utilization 45 days post index encounter
Primary care	1.30	2.21	0.75	1.46	<.001	1.52	2.78	1.60	2.47	.096
Emergency department	0.34	0.89	0.14	0.56	<.001	0.43	1.06	0.32	0.81	<.001
Psychiatry/AOD treatment	12.50	26.50	0.78	4.78	<.001	26.06	35.61	2.28	9.71	<.001

* Initiation was estimated among patients with an index encounter in an outpatient or ED setting (i.e., not inpatient) (n = 70,079).

** Engagement was estimated among all patients who initiated AOD treatment, including patients with an index inpatient encounter (n = 24,188).

Table 3. Characteristics associated with treatment initiation and engagement.

	Treatment initiation*				Treatment engagement**
Characteristic	OR	95% CI		P value	OR	95% CI		P value
Sex
Female	0.81	0.76	0.86	<.001	0.92	0.82	1.04	.144
Male (ref)	—	—	—	—	—	—	—	—
Age
18–29 (ref)	—	—	—	—	—	—	—	—
30–49	1.11	1.04	1.19	.005	1.26	1.10	1.43	.002
50–64	1.07	1.00	1.15	.066	0.99	0.86	1.13	.871
65+	0.82	0.74	0.90	<.001	0.51	0.43	0.62	<.001
Race/ethnicity
American Indian/Alaska Native	0.90	0.72	1.12	.335	0.92	0.62	1.38	.688
Asian	0.83	0.72	0.95	.011	0.92	0.70	1.20	.512
Native Hawaiian/other Pacific Islander	0.83	0.60	1.15	.247	0.81	0.45	1.48	.482
Black/African American	0.82	0.75	0.90	.001	0.64	0.53	0.77	<.001
Hispanic	0.85	0.79	0.91	<.001	0.90	0.79	1.02	.101
Other/unknown	0.94	0.84	1.05	.255	0.99	0.81	1.22	.952
White (ref)	—	—	—	—	—	—	—	—
Substance abuse–related psychiatric conditions in prior year	1.26	1.18	1.35	<.001	1.11	0.98	1.24	.061
Substance abuse–related medical conditions in prior year	1.18	1.10	1.26	<.001	0.87	0.77	0.99	.040
Index encounter type
Emergency department	1.55	1.45	1.66	<.001	—	—	—
Inpatient	n/a	n/a	n/a	n/a	—	—	—
Psychiatry/AOD treatment	3.58	3.33	3.84	<.001	—	—	—
Other outpatient	1.19	1.06	1.32	.004	—	—	—
Primary Care (ref)	—	—	—	—
Initiation encounter type
Inpatient	—	—	—		0.40	0.32	0.50	<.001
Psychiatry/AOD treatment	—	—	—		7.02	5.93	8.31	<.001
Other outpatient	—	—	—		0.73	0.59	0.91	.008
Unknown	—	—	—		0.67	0.55	0.81	<.001
Primary care (ref)	—	—	—	—	—	—	—	—

* Initiation was estimated among patients with an index encounter in an outpatient or ED setting (i.e., not inpatient) (n = 70,079).

** Engagement was estimated among all patients who initiated AOD treatment, including patients with an index inpatient encounter (n = 24,188).

Table 4. Organizational characteristics associated with treatment initiation and engagement.

	Treatment initiation*			Treatment engagement**
Characteristic	OR	95% CI	P value	OR	95% CI	P value
Primary care and specialty AOD treatment co-located
At least 1 clinic but not all	2.77	1.89 4.05	.001	3.55	1.50 8.43	.013
None (ref)	—	—	—	—	—	—
Specialty treatment only available internally (excluding methadone treatment)
At least 1 clinic but not all	1.73	0.94 3.18	.070	2.27	1.07 4.83	.038
None (ref)	—	—	—	—	—	—
Medication-assisted treatment availability in primary care
All clinics	1.44	0.48 4.38	.411	1.33	0.34 5.25	.593
At least 1 clinic but not all	1.20	0.54 2.65	.563	1.78	0.66 4.78	.179
None (ref)	—	—	—	—	—	—
Medication-assisted treatment availability in specialty treatment
All clinics	1.29	0.64 2.60	.399	1.08	0.40 2.92	.856
At least 1 clinic but not all (ref)	—	—	—	—	—	—
Behavioral medicine specialist availability in primary care
All clinics	1.47	0.58 3.96	.338	0.80	0.17 3.72	.706
At least 1 clinic but not all	0.93	0.35 2.48	.842	0.65	0.14 3.05	.485
None (ref)	—	—	—	—	—	—
EHR use for referrals to specialty AOD treatment
All clinics	0.98	0.68 1.41	.880	0.54	0.33 0.88	.025
At least 1 clinic but not all	0.35	0.21 0.58	.005	0.17	0.08 0.36	.003
None (ref)	—	—	—	—	—	—

Note. All models were run separately for each measure due to collinearity; models adjust for gender, age, race/ethnicity, and Charlson index.

* Initiation was estimated among patients with an index encounter in an outpatient or ED setting (i.e., not inpatient) (n = 70,079).

** Engagement was estimated among all patients who initiated AOD treatment, including patients with an index inpatient encounter (n = 24,188).

Table

Substance abuse–related medical condition (SAMC)^16^,^31–35	ICD-9 code
Depression	296.2, 296.3, 296.82, 298.0, 300.4, 301.12, 309.0, 309.1, 309.28, 311
Injury and poisonings	800-999
Anxiety and nervous disorders	300.00, 300.01, 300.02, 300.2, 300.3, 309.21, 309.24, 309.81, 308.3
Hypertension	362.11, 401, 403, 402.00, 404.10, 402.90, 404.0, 405
Asthma	493
Psychoses	295, 297, 298.1, 298.2, 298.3, 298.4, 298.8, 298.9, 296.0, 296.1, 296.4, 296.5, 296.6, 296.7, 296.80, 296.81, 296.89, 296.9
Acid-related disorders	530.1, 531, 532, 533, 535, 536.8
Ischemic heart disease	410, 411, 412, 413, 414
Pneumonia	480, 481, 482, 483, 484, 485, 486, 487
Chronic obstructive pulmonary disease	490, 491, 492, 494, 496
Liver cirrhosis	571
Hepatitis C	070.41, 070.44, 070.51, 070.54
Diseases of the pancreas	577
Alcoholic gastritis	535.3
Toxic effects of alcohol (ethyl and unspecified)	980.0, 980.9
Alcohol neuropathy	357.5
Drug neuropathy	357.6
Alcoholic cardiomyopathy	425.5
Excess blood alcohol level	790.3
Poisoning by alcohol	E86.0
Drug dependence in mother-childbirth	648.3

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